Provider Demographics
NPI:1194992602
Name:STONEHEDGE ACQUISITION ROME LLC ADC
Entity type:Organization
Organization Name:STONEHEDGE ACQUISITION ROME LLC ADC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-215-6000
Mailing Address - Street 1:801 N JAMES ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-3524
Mailing Address - Country:US
Mailing Address - Phone:315-533-1600
Mailing Address - Fax:315-337-7359
Practice Address - Street 1:801 N JAMES ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-3524
Practice Address - Country:US
Practice Address - Phone:315-533-1600
Practice Address - Fax:315-337-7359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3201309N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02005365Medicaid